[Blood management in geriatric hospitalized population]. / Épargne transfusionnelle dans la population âgée hospitalisée.

INTRODUCTION: In France, nearly 50% of patients transfused in packed red blood cells are 75 or older. The benefit of restrictive transfusion policies is no longer to be demonstrated, but the practices are still far from it. The objective of our study was to show the impact of a decision support tool on transfusion practices, specifically in a hospitalized elderly population. METHOD: A clinical decision support, validated in the improvement of practices, was created, based on the latest transfusion recommendations of 2014. Our study was interventional, monocentric, within the departments of internal medicine and geriatrics of a university hospital from February to July 2016. The clinical decision support was available for any request of transfusion of packed red blood cells for 75 years old or older patient who was hospitalized in one of these two services. RESULTS: There were 134 transfusions out of 173 for which the prescriber used our tool. Comparing 2016 with the previous two years, our tool decreased the rate of packed red blood cells delivered by 11% compared to 2014 (P<0.005), but there was no significant difference compared to 2015. It has also reduced the transfusion rate of multi-unit transfusions by 35% compared with 2014 and by 29% compared with 2015 (P<0.005). CONCLUSION: Our tool, applied specifically to the elderly, is useful to improve transfusion practices and requires to be validated on a larger scale.

Comparison of intensive-care-unit-acquired infections and their outcomes among patients over and under 80 years of age.

BACKGROUND: Patients aged >80 years represent a growing population admitted to intensive care units (ICUs). However, little is known about ICU-acquired infection (IAI) in this population, and the rate of invasive procedures is increasing. AIM: To evaluate the frequency and effects of IAI in elderly (≥80 years) and younger patients. METHODS: Retrospective evaluation of consecutive patients hospitalized for three days or more over a three-year period in an 18-bed ICU in an academic medical centre. FINDINGS: Elderly patients represented 18.9% of the study population. At admission, the mean number of organ dysfunctions was similar in elderly and younger patients. The use of invasive procedures was also similar in elderly and younger patients, as follows: invasive mechanical ventilation for more than two days, 67.4% vs 55%; central venous catheterization, 56.9% vs 51.4%; and renal replacement therapy, 17.6% vs 17.8%, respectively. The frequency of IAI was 16.5% in elderly patients and 13.9% in younger patients (P = 0.28), with 20.5 vs 18.9 IAI episodes per 1000 ICU-days, respectively (P = 0.2). A Cox model identified central venous catheterization and invasive mechanical ventilation for more than two days as independent risk factors for IAI. The associations between IAI and prolonged ICU stay, increased nursing workload, and ICU and hospital mortality rates were similar in elderly and younger patients. CONCLUSIONS: The frequency of IAI was similar in elderly and younger patients, as were the associations between IAI and length of ICU stay, nursing workload and ICU mortality in an ICU with a high rate of invasive procedures.